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Ma form nob1 bulletin 133

Ma form nob1 bulletin 133 2025

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4.8 out of 5

104 votes

The document is a bulletin from the Massachusetts Executive Office of Health and Human Services regarding the revised Notification of Birth (NOB-1) form used by hospitals for newborn eligibility determinations and health-plan enrollment under MassHealth and Commonwealth Care programs. It outlines the changes to the NOB-1 form, the enrollment process for newborns, and details about Commonwealth Care, which provides health insurance subsidies for residents not eligible for MassHealth. The bulletin emphasizes the importance of using the updated NOB-1 form immediately while still accepting the old version until February 2007.

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Click ‘Get Form’ to open the NOB-1 form in the editor.
In Section I, enter the mother's RID/SSN and casehead RID/SSN if applicable. Ensure to include the 10th digit in the designated box.
Fill in the mother’s name, address, date of birth, and phone number accurately.
Select whether the mother is enrolled in MassHealth or Commonwealth Care by checking the appropriate box and indicating her MCO.
Move to Section II and input the child's name, date of birth (MM/DD/YYYY), sex, birth weight, and race code as required.
Indicate if a social security application has been made for the child. Finally, sign and date the form with your title.
Ensure both copies of the original NOB-1 form are ready for mailing to MassHealth Enrollment Center.

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Versions	Form popularity	Fillable & printable
2007	4.8 Satisfied (104 Votes)

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